游离股前外侧穿支皮瓣修复口腔颌面部巨大软组织缺损临床效果观察  

Clinical observation on the repair of large soft tissue defects in the oral and maxillofacial region using a free anterolateral thigh perforator flap

作　　者：张宏[1] 王军[1] 范向达[1] 王娟[1] 张建伟[1] 宋一丁[1] ZHANG Hong;WANG Jun;FAN Xiang-da(Gansu Provincial Cancer Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省肿瘤医院,730050

出　　处：《中国实用医药》2025年第3期62-66,共5页China Practical Medicine

基　　金：甘肃省卫生行业科研计划项目(项目编号:GSWSKY2022-21),项目名称:游离股前外侧穿支皮瓣在头颈颌面部软组织缺损修复中的临床应用及研究;甘肃省科技计划项目(项目编号:21JR7RA678),项目名称:甘肃省头颈肿瘤临床医学研究中心;国家临床重点专科建设项目资金支持(项目编号:甘财社(2021)80号)。

摘　　要：目的探讨头颈部恶性肿瘤扩大切除术后口腔颌面部巨大软组织缺损利用游离股前外侧穿支皮瓣(ALTPF)修复的临床效果。方法回顾性分析40例因头颈部恶性肿瘤行扩大切除术后造成的口腔颌面部巨大软组织缺损利用游离股前外侧穿支皮瓣修复患者的临床资料,根据肿瘤切除术后的缺损范围制备游离股前外侧皮瓣,最大切取面积为32.0 cm×12.0 cm,最小切取面积为3.5 cm×7.0 cm,大腿部供区均直接拉拢缝合,术后观察皮瓣的成活率、术后并发症发生情况,评估受区及供区外形及功能恢复情况、肿瘤复发情况。结果术后38例患者的游离股前外侧穿支皮瓣全部成活,1例患者术后出现静脉危像,1例患者术后出现动脉危像,经急诊抢救取出血栓后皮瓣存活,大腿部供区均直接拉拢缝合,且均一期愈合,术后每3~6个月复查1次,大腿部供区均恢复良好,其中1例口颊癌因病期较晚术后1年肿瘤复发,予以免疫化疗(信迪利单抗+白蛋白紫杉醇+顺铂)及二次手术治疗。结论游离股前外侧穿支皮瓣因其血管与颈部血管粗细一致,术后皮瓣成活率高,且对供区影响小,可有效修复头颈部恶性肿瘤扩大切除术后的口腔颌面部巨大软组织缺损,值得在临床推广应用。Objective To explore the clinical effect of using free anterolateral thigh perforator flap(ALTPF)to repair large soft tissue defects after extensive resection of head and neck malignant tumors.Methods The clinical data of 40 patients with large soft-tissue defects after extensive resection of head and neck malignant tumors were retrospectively analyzed.A free anterolateral thigh perforator flap was prepared based on the defect range after tumor resection,with a maximum cutting area of 32.0 cm×12.0 cm and a minimum cutting area of 3.5 cm×7.0 cm.The thigh donor area was all closed and sutured directly,and the survival rate of the skin flap and occurrence of postoperative complications were observed,and the appearance and functional recovery of the recipient and donor areas,and tumor recurrence were evaluated.Results All 38 patients'free anterolateral thigh perforator flaps survived after surgery.1 patient showed venous risk after surgery,and 1 patient showed arterial risk after surgery.After emergency rescue,the thrombus was removed and the flaps survived.The thigh donor site was all closed and sutured,and all had stageⅠhealing.Follow up examinations were conducted every 3-months after surgery,and the thigh donor site recovered well.1 patient with oral and cheek cancer had tumor recurrence 1 year later due to late stage of the disease,and was treated with immunotherapy(sintilimab+albumin paclitaxel+cisplatin)and secondary surgery.Conclusion The free anterolateral thigh perforator flap has a high survival rate and minimal impact on the donor site due to its blood vessels being the same thickness as those in the neck.It can effectively repair large soft tissue defects after extensive resection of head and neck malignant tumors,and is worthy of clinical promotion and application.

关 键 词：游离股前外侧穿支皮瓣 头颈部恶性肿瘤 软组织缺损 皮瓣修复 

分 类 号：R739.91[医药卫生—肿瘤] R782.2[医药卫生—临床医学]